| Gary W Gossage Licensed Clinical Social Work | |
|
1910 Payton Cir Colorado Springs CO 80915-1327 | |
| (701) 400-2592 | |
| (719) 631-0577 |
| Full Name | Gary W Gossage Licensed Clinical Social Work |
|---|---|
| Speciality | Social Worker |
| Location | 1910 Payton Cir, Colorado Springs, Colorado |
| Authorized Official Name and Position | Gary W Gossage (OWNER) |
| Authorized Official Contact | 7014002592 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary W Gossage Licensed Clinical Social Work 1910 Payton Cir Colorado Springs CO 80915-1327 Ph: (701) 400-2592 | Gary W Gossage Licensed Clinical Social Work 1910 Payton Cir Colorado Springs CO 80915-1327 Ph: (701) 400-2592 |
| NPI Number | 1487288510 |
|---|---|
| Provider Enumeration Date | 02/27/2020 |
| Last Update Date | 03/03/2020 |
| Certification Date | 03/03/2020 |
| Medicare PECOS PAC ID | 8224466750 |
|---|---|
| Medicare Enrollment ID | O20200317000997 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487288510 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Gary W Gossage |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174675425 PECOS PAC ID: 6305835000 Enrollment ID: I20040508000020 |
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